The Importance of Pre-Cleaning Instruments at the Point of Use
Point-of-Use Cleaning is the first step in the decontamination and reprocessing of medical and surgical instruments. This step begins during or immediately after a medical procedure, when visible soil, blood, tissue, and body fluids are removed from instruments before they are transported to the Central Sterile Services Department (CSSD) for complete cleaning, disinfection, and sterilization. Point-of-use cleaning does not replace the complete cleaning process; rather, it is an essential preparatory step.
The importance of this practice lies in preventing contaminants from drying on instrument surfaces. Blood, tissue, body fat, and body fluids become more difficult to remove once they dry and may affect the effectiveness of subsequent reprocessing stages. Early removal of gross soil helps make cleaning easier, reduces the risk of corrosion, prevents dried debris, and supports effective sterilization.
Early treatment also helps protect instruments and extend their service life, while reducing the need for more aggressive cleaning methods that may become necessary when contamination is allowed to dry. The content also highlights the importance of preventing conditions that encourage the formation of biofilm—communities of microorganisms attached to surfaces and protected by a sticky layer, making them more difficult to remove and more resistant to cleaning and disinfecting agents.
Key point-of-use cleaning practices include removing gross soil, keeping instruments moist, opening hinged instruments, separating sharps, removing disposable components, and keeping instrument sets together until they reach the CSSD.
Sharp instruments, including scalpels, needles, scissors, and certain bone instruments, require special handling. They should be separated and placed in appropriate puncture-resistant containers while minimizing direct contact to help reduce the risk of sharps injuries during transportation and processing. Reusable linen and waste should also be separated from instruments and placed in their appropriate containers.
Another important practice is keeping instruments moist to prevent contaminants from drying on their surfaces. Appropriate methods may include moist towels, foam or gel sprays, and approved enzymatic products. However, instruments should not be left soaking in solutions for extended periods, as prolonged soaking may damage their surfaces, contribute to corrosion, and reduce their service life.
Special attention is also required when handling flexible endoscopes and multi-part instruments, with staff following the manufacturer's instructions for use. Hinged instruments should be opened, multi-part instruments should be disassembled as appropriate, and instruments should be arranged correctly within trays. Heavy instruments should be positioned at the bottom with lighter instruments above them, while instrument sets should remain together during transportation to reduce missing components and improve workflow efficiency.
In special situations, such as when instruments have been used in a suspected or confirmed case of Creutzfeldt-Jakob Disease (CJD), the CSSD and infection prevention team should be notified, and the facility's established protocol for initial cleaning should be followed. Damaged instruments or those requiring repair should also be identified, separated from active sets, and reported to the CSSD to support safety and prevent procedural delays.
Ultimately, point-of-use cleaning is an essential part of the instrument reprocessing system. Applying appropriate practices from the moment an instrument is used helps facilitate subsequent cleaning, protect instrument integrity, reduce contamination and occupational risks, improve CSSD workflow, and support the safety of both patients and healthcare professionals.
Prepared by: Dr. Warda Abdelmoaty Azab
Treasurer of the Egyptian Society of Sterilization Practice (ESSP) – HSPA Certified Professional (CRCST)